Dual-dispatch protocols and return of spontaneous circulation in patients with out-of-hospital cardiac arrest: a nationwide observational study

Abstract

Objective The Korean National Fire Agency conducted a pilot project examining Advanced Life Support (ALS) protocols, including epinephrine administration, to improve survival among patients suffering out-of-hospital cardiac arrest (OHCA). In this study, we aimed to evaluate the effects of the Korean National Fire Agency ALS protocol on prehospital return of spontaneous circulation (ROSC) in patients with OHCA. Methods This study included patients with adult-presumed cardiac arrest between January and December 2020. The main factor of interest was ambulance type according to ALS protocol, which was divided into dedicated ALS ambulance (DA), smartphone-based ALS ambulance (SALS), and non-DA, and the main analysis factor was prehospital ROSC. Multivariable logistic regression analysis was performed. Results During the study period, a total of 18,031 adult patients with OHCA was treated by the emergency medical services, including 7,520 DAs (41.71%), 2,622 SALSs (14.54%), and 7,889 non-DAs (43.75%). The prehospital ROSC rate of the DA group (13.19%) was higher than those of the non-DA group (7.91%) and the SALS group (11.17%, P<0.01). Compared with that of the DA group, the adjusted odds ratios (95% confidence interval) for prehospital ROSC were 0.97 (0.82–1.15) in the SALS group and 0.57 (0.50–0.65) in the non-DA group. Conclusion ALS protocol intervention was associated with prehospital ROSC rates. Therefore, continuous efforts to promote systemic implementation of the ALS protocol to improve OHCA outcomes are necessary.

Keywords

• advanced cardiac life support
• out-of-hospital cardiac arrest
• emergency medical services
• return of spontaneous circulation
• epinephrine